Canadian Journal of Gastroenterology最新文献

{"title":"The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada.","authors":"Desmond Leddin,&nbsp;David Armstrong,&nbsp;Mark Borgaonkar,&nbsp;Ronald J Bridges,&nbsp;Carlo A Fallone,&nbsp;Jennifer J Telford,&nbsp;Ying Chen,&nbsp;Palma Colacino,&nbsp;Paul Sinclair","doi":"10.1155/2013/143018","DOIUrl":"https://doi.org/10.1155/2013/143018","url":null,"abstract":"<p><strong>Background: </strong>Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time.</p><p><strong>Methods: </strong>During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005.</p><p><strong>Results: </strong>Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (P<0.05); the wait time to same-day consultation and procedure was shorter in 2012 than in 2008 (78 days versus 101 days; P<0.05), but continued to be longer than in 2005 (P<0.05). The total wait time remained longest for screening colonoscopy, increasing from 201 days in 2008 to 279 days in 2012 (P<0.05).</p><p><strong>Discussion: </strong>Wait times for gastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 2","pages":"83-9"},"PeriodicalIF":2.7,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/143018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31291591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Younger age and prognosis in diverticulitis: a nationwide retrospective cohort study.","authors":"Roshan Razik,&nbsp;Christopher A Chong,&nbsp;Geoffrey C Nguyen","doi":"10.1155/2013/341501","DOIUrl":"https://doi.org/10.1155/2013/341501","url":null,"abstract":"<p><strong>Background: </strong>Traditionally regarded as a disease of the elderly, the incidence of diverticulitis of the colon has been on the rise, especially in younger cohorts. These patients have been found to experience a more aggressive disease course with more frequent hospitalization and greater need for surgical intervention.</p><p><strong>Objective: </strong>To characterize factors that portend a poor prognosis in patients diagnosed with diverticulitis; in particular, to evaluate the role of demographic variables on disease course.</p><p><strong>Methods: </strong>Using the Canadian Institute for Health Information Discharge Abstract Databases, readmission rates, length of stay, colectomy rates and mortality rates in patients hospitalized for diverticulitis were examined. Data were stratified according to age, sex and comorbidity (as defined by the Charlson index).</p><p><strong>Results: </strong>In the cohort ≤30 years of age, a clear male predominance was apparent. Colectomy rate in the index admission, stratified according to age, demonstrated a J-shaped curve, with the highest rate in patients ≤30 years of age (adjusted OR 2.3 [95% CI 1.62 to 3.27]) compared with the 31 to 40 years of age group. In-hospital mortality increased with age. Cumulative rates of readmission at six and 12 months were 6.8% and 8.8%, respectively.</p><p><strong>Conclusion: </strong>In the present nationwide cohort study, younger patients (specifically those ≤30 years of age) were at highest risk for colectomy during their index admission for diverticulitis. It is unclear whether this observation was due to more virulent disease among younger patients, or surgeon and patient preferences.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 2","pages":"95-8"},"PeriodicalIF":2.7,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/341501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31291593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of hepatic expression of STAT1, SOCS3 and PIAS1 in the response of chronic hepatitis C patients to therapy.","authors":"Sherif El-Saadany,&nbsp;Dina H Ziada,&nbsp;Hanan El Bassat,&nbsp;Wael Farrag,&nbsp;Hesham El-Serogy,&nbsp;Manal Eid,&nbsp;Manal Abdallah,&nbsp;Medhat Ghazy,&nbsp;Hoda A Salem","doi":"10.1155/2013/562765","DOIUrl":"https://doi.org/10.1155/2013/562765","url":null,"abstract":"<p><strong>Background: </strong>The underlying mechanisms of hepatitis C virus (HCV) resistance to treatment are unknown. Signal transducers and activators of transcription (STAT) proteins play a critical role in antiviral defense.</p><p><strong>Objective: </strong>To explore some of the mechanisms of HCV resistance to interferon, the expression of STAT1 and its negative regulators, protein inhibitor of activated STAT (PIAS1) and suppressor of cytokine signalling (SOCS3), in liver tissues of both inteferon responders and nonresponders in chronic HCV patients.</p><p><strong>Methods: </strong>Sixty patients were divided into the following groups: group 1a comprised 38 treatment-responder chronic HCV patients; group 1b consisted of 22 treatment-nonresponder chronic HCV patients; and group 2 consisted of six control subjects. Liver biopsies were examined for histological scoring; STAT1, SOCS3 and PIAS1 expression was analyzed using Western blotting methods.</p><p><strong>Results: </strong>STAT1 expression in the liver tissue of patients in group 1 was significantly increased compared with group 2 patients (P=0.001), while no significant difference in expression was observed between group 1a and group 1b patients (P=0.747). However, phosphorylated STAT1 protein was expressed at a significantly higher level in liver tissue of patients in group 1a compared with patients in group 1b (P=0.001). Western blot analysis of PIAS1 and SOCS3 protein expression in liver tissues from groups 1 and 2 revealed significantly increased expression in group 1 compared with group 2 (P=0.001). In addition, PIAS1 and SOCS3 protein expression was significantly higher in the liver tissues of patients in group 1b compared with patients in group 1a.</p><p><strong>Conclusion: </strong>Levels of STAT1 and⁄or the protein expression of its negative regulators, PIAS1 and SOCS3, may be a good predictor of response to therapy. These could be used as biomarkers that are easily detected by Western blotting or immunostaining during standard histopathological liver biopsy analysis.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 2","pages":"e13-7"},"PeriodicalIF":2.7,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/562765","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31291595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Canadian Digestive Diseases Week 2013 and the Annual CASL (Canadian Association for the Study of the Liver) Winter Meeting. March 1-4, 2013. Victoria, British Columbia, Canada.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 Suppl A ","pages":"71A-178A"},"PeriodicalIF":2.7,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31385136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of recurrent ingestion of gastrointestinal foreign bodies.","authors":"Ian C Grimes,&nbsp;Bret J Spier,&nbsp;Lisa R Swize,&nbsp;Mary J Lindstrom,&nbsp;Patrick R Pfau","doi":"10.1155/2013/671273","DOIUrl":"https://doi.org/10.1155/2013/671273","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal foreign bodies are commonly encountered; however, little knowledge exists as to the causes of foreign body ingestions and why they occur repeatedly in some patients.</p><p><strong>Objective: </strong>To identify and define patients at high risk for recurrent foreign body ingestion.</p><p><strong>Methods: </strong>A retrospective chart review of foreign body ingestion was conducted at a tertiary care medical centre over an 11-year period. Variables analyzed included age, sex, incarceration status, Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis, success of endoscopy, type of sedation used, method of extraction, complications, presence of gastrointestinal pathology, and incidence of recurrent food impaction or foreign body.</p><p><strong>Results: </strong>A total of 159 patients with a foreign body ingestion were identified. One hundred fourteen (77%) experienced a single episode of ingestion and 45 (23%) experienced multiple ingestions. Of the patients with multiple ingestions, 27 (60%) had recurrent food impactions while 18 (40%) ingested foreign objects. In the recurrent ingestor group, a psychiatric disorder had been diagnosed in 16 patients (35.6%) and there were 13 incarcerated individuals (28.9%). The average number of recurrences was 2.6 per patient (117 total recurrences). Individuals with a psychiatric disorder experienced 3.9 recurrences per patient, while prisoners averaged 4.1 recurrences per patient. The combination of a psychiatric disorder and being incarcerated was associated with the highest recurrence rate (4.33 per patient). Multivariable logistic regression revealed that male sex (OR 2.9; P=0.022), being incarcerated (OR 3.0; P=0.024) and the presence of a psychiatric disorder (OR 2.5; P=0.03) were risk factors for recurrent ingestion.</p><p><strong>Conclusion: </strong>Risk factors for recurrent ingestion of foreign bodies were male sex, being incarcerated and the presence of a psychiatric disorder.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 1","pages":"e1-4"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/671273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31212961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of core and advanced adult gastrointestinal endoscopy training in Canada: Survey of existing accredited programs.","authors":"Xin Xiong,&nbsp;Alan N Barkun,&nbsp;Kevin Waschke,&nbsp;Myriam Martel","doi":"10.1155/2013/186284","DOIUrl":"https://doi.org/10.1155/2013/186284","url":null,"abstract":"<p><strong>Objective: </strong>To determine the current status of core and advanced adult gastroenterology training in Canada.</p><p><strong>Methods: </strong>A survey consisting of 20 questions pertaining to core and advanced endoscopy training was circulated to 14 accredited adult gastroenterology residency program directors. For continuous variables, median and range were analyzed; for categorical variables, percentage and associated 95% CIs were analyzed.</p><p><strong>Results: </strong>All 14 programs responded to the survey. The median number of core trainees was six (range four to 16). The median (range) procedural volumes for gastroscopy, colonoscopy, percutaneous endoscopic gastrostomy and sigmoidoscopy, respectively, were 400 (150 to 1000), 325 (200 to 1500), 15 (zero to 250) and 60 (25 to 300). Eleven of 13 (84.6%) programs used endoscopy simulators in their curriculum. Eight of 14 programs (57%) provided a structured advanced endoscopy training fellowship. The majority (88%) offered training of combined endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography. The median number of positions offered yearly for advanced endoscopy fellowship was one (range one to three). The median (range) procedural volumes for ERCP, endoscopic ultrasonography and endoscopic mucosal resection, respectively, were 325 (200 to 750), 250 (80 to 400) and 20 (10 to 63). None of the current programs offered training in endoscopic submucosal dissection or natural orifice transluminal endoscopic surgery.</p><p><strong>Conclusion: </strong>Most accredited adult Canadian gastroenterology programs met the minimal procedural requirements recommended by the Canadian Association of Gastroenterology during core training. However, a more heterogeneous experience has been observed for advanced training. Additional studies would be required to validate and standardize evaluation tools used during gastroenterology curricula.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 5","pages":"267-72"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/186284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31552695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the diagnosis of enteropathy-associated T cell lymphoma.","authors":"Pernilla Marissa D'Souza,&nbsp;Safwat Girgis,&nbsp;Christopher Wayne Teshima","doi":"10.1155/2013/168593","DOIUrl":"https://doi.org/10.1155/2013/168593","url":null,"abstract":"DISCLOSURES: The authors have no financial disclosures or potential conflicts of interest to declare.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 5","pages":"255-6"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/168593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31674052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hedgehog signalling is downregulated in celiac disease.","authors":"Rui Liang,&nbsp;Rupert Hinds,&nbsp;Helen E Abud,&nbsp;Wei Cheng","doi":"10.1155/2013/676430","DOIUrl":"https://doi.org/10.1155/2013/676430","url":null,"abstract":"<p><strong>Background: </strong>Celiac disease (CD) is a common autoimmune disorder of the small intestine that occurs in genetically predisposed individuals. Animal studies have suggested that the hedgehog (Hh) signalling pathway is involved in gut inflammation, injury and repair.</p><p><strong>Objective: </strong>To examine the expression of components of the Hh signalling pathway in CD.</p><p><strong>Methods: </strong>Children undergoing gastroscopy investigation for CD at Monash University (Victoria, Australia), and other children undergoing gastroscopy in whom small bowel pathology was not expected (ie, controls), were included in the present study. One histopathologist, who was blinded to the biopsy data, analyzed the biopsies and a diagnosis of CD was made according to standard Marsh criteria. From these samples, RNA was extracted and complementary DNA was synthesized using reverse transcription polymerase chain reaction. The levels of Hh ligand Sonic hh, Indian hh, protein patched homologue 1 (PTCH 1) and bone morphogenetic protein 4 (BMP4) messenger RNA were quantified by real-time polymerase chain reaction. Relative expression quantification was performed using the ΔΔCt method.</p><p><strong>Results: </strong>Duodenal biopsies were collected from 37 children. There were 20 CD specimens and 17 normal controls. The relative expression of Sonic hh from CD patients was 58% lower than that of the controls; similarly, Indian hh expression was decreased in children with CD by 44%. Compared with controls, the expression of Hh receptor PTCH 1 decreased by 71% and the expression of the Hh target gene BMP4 by 42%.</p><p><strong>Conclusions: </strong>The expression of the Hh signalling pathway genes was consistently downregulated in untreated CD children. These results suggest that the Hh signalling pathway plays a role in the mucosal lesions encountered in CD.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 1","pages":"e5-7"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/676430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31212962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction with the endoscopy experience and willingness to return in a central Canadian health region.","authors":"Russell Loftus,&nbsp;Zoann Nugent,&nbsp;Lesley A Graff,&nbsp;Frederick Schumacher,&nbsp;Charles N Bernstein,&nbsp;Harminder Singh","doi":"10.1155/2013/615206","DOIUrl":"https://doi.org/10.1155/2013/615206","url":null,"abstract":"<p><strong>Objective: </strong>Patient experiences with endoscopy visits within a large central Canadian health region were evaluated to determine the relationship between the visit experience and the patients' willingness to return for future endoscopy, and to identify the factors associated with patients' willingness to return.</p><p><strong>Methods: </strong>A self-report survey was distributed to 1200 consecutive individuals undergoing an upper and⁄or lower gastrointestinal endoscopy at any one of the six hospital-based endoscopy facilities in the region. The Spearman correlation coefficient was used to assess the association between the patients' overall rating of the visits and willingness to return for repeat procedures under similar medical circumstances. Logistic regression analyses were performed to identify the factors associated with willingness to return for repeat endoscopy and overall satisfaction (rating) of the visit.</p><p><strong>Results: </strong>A total of 529 (44%) individuals returned the questionnaire, with 45% rating the visit as excellent and 56% indicating they were extremely likely to return for repeat endoscopy. There was a low moderate correlation between overall rating of the visit and patients' willingness to return for repeat endoscopy (r=0.30). The factors independently associated with patient willingness to return for repeat endoscopy included perceived technical skills of the endoscopists (OR 2.7 [95% CI 1.3 to 5.5]), absence of pain during the procedure (OR 2.2 [95% CI 1.3 to 3.6]) and history of previous endoscopy (OR 2.4 [95% CI 1.4 to 4.1]). In contrast, the independent factors associated with the overall rating of the visit included information provided pre- and postprocedure, wait time before and on the day of the visit, and the physical environment.</p><p><strong>Conclusions: </strong>To facilitate patient return for needed endoscopy, it is important to assess patients' willingness to return because positive behavioural intent is not simply a function of satisfaction with the visit.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 5","pages":"259-66"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/615206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31552694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenicity, host responses and implications for management of enterohemorrhagic Escherichia coli O157:H7 infection.","authors":"Nathan K Ho,&nbsp;Aleah C Henry,&nbsp;Kathene Johnson-Henry,&nbsp;Philip M Sherman","doi":"10.1155/2013/138673","DOIUrl":"https://doi.org/10.1155/2013/138673","url":null,"abstract":"<p><p>Enterohemorrhagic Escherichia coli serotype O157:H7 is a food- and waterborne pathogen that causes significant morbidity and mortality in both developing and industrialized nations. The present review focuses on the history, epidemiology and evolution of the pathogen; provides a mechanistic overview of major virulence factors (including Shiga toxins, locus of enterocyte effacement pathogenicity island and pO157 plasmid); discusses host immune responses to infection; considers available animal models; and provides an overview of current and potential future management considerations.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 5","pages":"281-5"},"PeriodicalIF":2.7,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/138673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31553783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}